与高级住院医师相比，主治医生直接监督对新手麻醉住院医师监督质量的有效性：一项随机研究。
The Effectiveness of Direct Supervision by an Attending Compared To a Senior Resident on Quality of Supervision of Novice Anesthesiology Residents: A Randomized Study.
作者信息
Malgieri Christopher, Kendall Mark C, Rajaee Arezoo, Hoffman Ian, Apruzzese Patricia, Oliveira Gildasio De
机构信息
The following authors are in the Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI: is Assistant Professor of Anesthesiology; is Associate Professor of Anesthesiology; and are Residents, Anesthesiology; and is Professor of Anesthesiology. is a Biostatistician in the Department of Anesthesiology, Rhode Island Hospital, Providence, Rhode Island.
出版信息
J Educ Perioper Med. 2023 Dec 27;25(4):E718. doi: 10.46374/volxxv_issue4_Kendall. eCollection 2023 Oct-Dec.
BACKGROUND
New trainees are directly supervised by either an attending physician or a senior resident under indirect supervision from an attending physician. The main objective was to evaluate which type of direct supervision (attending vs. senior resident) would result in better quality of supervision to novice residents during their first month of training.
METHODS
Novice anesthesiology residents were randomized to receive direct supervision by an attending anesthesiologist or a senior resident during their introduction month of intraoperative anesthesia. The primary outcome was a validated instrument to evaluate supervision performance of the instructor. The secondary outcome was a validated anxiety scale.
RESULTS
The overall mean supervision score across the study days was greater in the residents who were directly supervised by attendings, mean (standard error [SE]) of 3.88 ± 0.03 compared with direct supervision by a senior resident, mean (SE) of 3.77 ± 0.03 a mean difference of 0.11 (95% confidence interval [CI], 0.05-0.16), = .0012. Five of 9 individual items on the supervision survey were significantly greater in the group directly supervised by attendings compared with residents. There was no difference between groups regarding anxiety scores. In contrast, there was a mild association between supervision scores and Spielberger State-Trait Anxiety Inventory-6 anxiety scores, correlation coefficient = 0.23 (95% CI, 0.08-0.39), < .0035.
CONCLUSIONS
We detected better supervision scores when novice anesthesiology residents were directly supervised by attendings when compared with senior residents. Nevertheless, direct supervision by senior residents still provided supervision scores consistent with a safe supervision practice.
背景
新学员由主治医师直接监督，或由高级住院医师在主治医师的间接监督下进行。主要目的是评估哪种直接监督类型（主治医师与高级住院医师）在新手住院医师培训的第一个月能带来更好的监督质量。
方法
将新手麻醉科住院医师随机分为两组，在术中麻醉的入门月分别接受麻醉主治医师或高级住院医师的直接监督。主要结局是一个用于评估带教老师监督表现的有效工具。次要结局是一个有效的焦虑量表。
结果
在研究期间，由主治医师直接监督的住院医师的总体平均监督得分更高，平均（标准误[SE]）为3.88±0.03，而由高级住院医师直接监督的平均（SE）为3.77±0.03，平均差异为0.11（95%置信区间[CI]，0.05 - 0.16），P = 0.0012。在监督调查的9个单项中，有5项在由主治医师直接监督的组中显著高于由高级住院医师监督的组。两组在焦虑得分方面没有差异。相比之下，监督得分与斯皮尔伯格状态 - 特质焦虑量表 - 6焦虑得分之间存在轻度关联，相关系数 = 0.23（95% CI，0.08 - 0.39），P < 0.0035。
结论
我们发现，与高级住院医师相比，新手麻醉科住院医师由主治医师直接监督时的监督得分更高。然而，由高级住院医师进行直接监督仍能提供与安全监督实践相符的监督得分。
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